Why Medicine Needs to Slow Down

More: For those who haven’t heard of it—what is “slow medicine”?
Victoria Sweet: As doctors, most of us practice “fast medicine,” which is kind of like fast food: It feeds you when you’re hungry and moves you along. Doctors get the diagnosis, give our treatments and check us out of the hospital as quickly as possible. It’s wonderful for what it does. But in the last 20 years, as health care economists have attempted to get ahold of costs they saw doctors’ time as expensive. The doctor now ends up with maybe 10 minutes per patient.

At Laguna Honda Hospital I practiced what I call “slow medicine.” When I’d first meet a patient, I would typically take about two hours to do a work-up: do a full physical exam, research everything that had been done with the patient, medications, the whole thing. Then I’d come up with the diagnoses and a plan—and I’d have time to institute that plan slowly.

More: What are a few suggestions that you have for improving the healthcare system—both in treatment of patients and cost of care?
VS: To give doctors back our time with patients. It’s been taken away because they thought doctors were expensive and that it would be more efficient to have a nursing assistant or a machine do tests. It’s not. In the book I talk about the inefficiency of “efficiency.” When everything is on the computer and tightly controlled and documented it ends up costing more money. I save the system money if I take enough time to diagnose a patient.

About a month ago, a national study came out saying that doctors are ordering too many MRIs. They’re ordering them for everyone with back pain, and we know that maybe only a quarter of those people need one. If I only have 10 minutes to examine a person with back pain, there’s no way I can determine if she needs the scan, so we just order one. MRIs cost around $1800. It might take me an hour to figure out, to my satisfaction, whether a patient needs an MRI. That’s what I call the inefficiency of efficiency.

More: How was Laguna Honda different from other hospitals?
It was unlike any hospital I’d ever been to or even imagined. Originally it was called the San Francisco almshouse, which is how we used to take care of the sick-poor before we had insurance. In the 1950s, just about all of them closed, except in San Francisco.

It was on 62 acres of land right in the middle of San Francisco, and yet most people didn’t even know that it existed. It had beautiful, open buildings that looked like medieval monastery. There were long open wards that would hold 30 or so patients. There was a barnyard and a greenhouse where patients could watch chickens hatch and grow plants. Laguna Honda was founded not on the idea that healthcare is a service that I provide to you, but that it’s a relationship between the doctor and the patient.

More: When did they begin renovating Laguna Honda?
VS: It was halfway through my time there that we were discovered. The health care economists were horrified by our open wards and basically told the city that they had to build a modern facility or they would shut us down. It took about 10 years to get it all done. It finally opened in December 2010. And it’s beautiful, it’s modern, patients have private rooms, there’s halogen lights, there’s cameras. There are two swimming pools—it’s very gorgeous. And everyone kind of misses the old place.

More: What have you learned through your PhD studies of the 12th century nun Hildegard of Bingen and her approach to medicine? How has it informed your own practices?
VS: In addition to being a nun, she was also a medical practitioner. Her medicine was based on a completely different model of the body than the mechanical model that we use today. The model we have today looks at the body as a machine made up of parts that are all connected. When someone’s sick, I ask myself what’s broken so that I can fix it. Hildegard’s model said that the body was more like a plant. Someone has to fix a broken machine, but a plant heals itself. She thought that, at its maximum, everybody’s body has the ability to heal itself.

I learned to do this at Laguna Honda. When patients weren’t doing well, I assumed they had the ability to heal themselves if there wasn’t something in the way. Then I’d try to figure out what was in the way of their healing power and move it so it could heal on its own. And it takes time to move those things. They could be too many medications, the wrong food, anxiety, depression, old tissue or a foreign body. Once they are moved, the healing power of body takes time.

More: How did you change as a doctor from working at Laguna Honda?
VS: As a doctor I do a lot less to patients than I used to do. I’m much more confident in my sense of who I think is sick and who I think is fundamentally well. I’m more inclined to sit and hang out with patients, absorb where they’re coming from and use that as a diagnostic clue. I much more consciously enjoy being a doctor.

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